Individual
SUSAN P HERTWECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3991 DUTCHMANS LN STE 303, LOUISVILLE, KY 40207-4723
(502) 559-1750
(502) 666-7707
Mailing address
PO BOX 766351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
25239
KY
2080A0000X
Pediatric Adolescent Medicine Physician
25239
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045416
ANTHEM - PSC
KY
01
—
000000047600
ANTHEM - FOUNDATION
KY
05
—
100332440
—
IN
01
—
1049241
PASSPORT PCP# - FOUNDATION
KY
01
—
1049243
PASSPORT SPECIALITY - FOUNDATION
KY
01
—
1049273
PASSPORT SPECIALITY - PSC
KY
01
—
50034184
PASSPORT & PASSPORT ADVTG
KY
05
—
64252398
—
KY
01
—
K027510
MEDICARE PTAN
KY
Enumeration date
07/17/2006
Last updated
05/26/2020
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